Tuberculosis osteoarticular en un paciente pediátrico / Osteoarticular tuberculosis in a pediatric patient

Introducción: La tuberculosis osteoarticular es una enfermedad inflamatoria crónica, muy rara con un cuadro clínico atípico y se presenta con una incidencia de 1-2 por ciento del total de los casos de tuberculosis. Objetivo: Exponer una forma de presentación poco frecuente de tuberculosis en Honduras Presentación del caso: Se trata de una niña de dos años con diagnóstico inicial de sinovitis en rodilla derecha de cinco meses de evolución y tratada con antibiótico y analgésico. Sin mejoría se presenta a emergencia con cambios inflamatorios. Se realiza rayos x de rodilla que muestran lesiones osteolíticas a nivel de rótula y cóndilo del fémur derecho. Baciloscopia de esputo y prueba de tuberculina negativas. Familiar de tercer grado positivo para tuberculosis hacía un año y medio. Por biopsia de tejido blando y óseo de rodilla derecha se establece el diagnóstico de artritis por Mycobacterium tuberculosis por estudio inmuno-histoquimico con tinción Ziehl Nielsen. Conclusiones: Es el primer informe de caso de tuberculosis osteoarticular en un paciente pediátrico descrito en Honduras. Por la larga evolución de la enfermedad, lo atípico de su clínica y su baja incidencia es difícil establecer el diagnóstico final. Fue imprescindible el estudio anatomopatológico por biopsia que permitiera esclarecer a los clínicos el diagnóstico e iniciar el tratamiento oportuno(AU)

Introduction: Osteoarticular tuberculosis is a chronic inflammatory disease, very rare, and with an atypical clinical picture and occurs with an incidence of 1-2 percent of all TB cases. Objective: Show a rare form of TB´s presentation in Honduras Case presentation: Two-year-old girl with an initial diagnosis of right knee synovitis of five months of evolution and treated with antibiotics and analgesics. Without improvement, she attends to emergencies service with inflammatory changes. Knee x-rays show osteolytic lesions at the kneecap level and the condyle of the right femur. Sputum bacilloscopy and negative tuberculin test were performed. She had a third-grade relative positive to tuberculosis a year and a half ago. A right knee soft tissue and bone biopsies confirm the diagnosis of arthritis by Mycobacterium tuberculosis by immuno-histochemical study with Ziehl Nielsen staining. Conclusions: It is the first osteoarticular TB case report in a pediatric patient described in Honduras. Because of the long evolution of the disease, the atypicalness of its clinic features and its low incidence, it is difficult to establish the final diagnosis. Anatomopathological study by biopsy was essential to clarify the diagnosis to clinicians and initiate timely treatment(AU)

Clinical Manifestations and Diagnosis of Extrapulmonary Tuberculosis

Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT. Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital. Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study. The most common site of the involvement was pleura (35.6%). The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain at the infected site (48.1%). Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively. Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old. In 67.3% of patients, tuberculosis was suspected at the initial visit. However, tuberculosis was microbiologically proven in only 23.7% of the patients. The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it. Based on our studies, only 11.2% of the patients were confirmed as EPT. So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study.

Tuberculosis osteoarticular: experiencia de 10 años / Osteoarticular tuberculosis: 10 year experience

Se realiza un estudio retrospectivo,entre 1990 y 1998, considerando 28 pacientes con diagnóstico de Tuberculosis (TBC)osteoarticular. La edad promedio de los pacientes fue de 49,5 años, siendo un 50 por ciento de sexo femenino. Las principales localizaciones osteoarticulares fueron: cadera con un 18 por ciento y rodilla con un 14 por ciento. El tiempo de evolución desde el inicio de los síntomas hasta el diagnóstico fue en promedio de 21, 5 meses, disminuyendo a 10,6 meses cuando existía compromiso neurológico. El tratamiento efectuado en un gran porcentaje de los casos fue asociado, comprendidendo éste la terapia antiTBC y el manejo quirúrgico. La evolución de los pacientes fue adecuada, sin embargo hubo un 60 por ciento de secuelas. La TBC ostearticular continúa siendo un problema, ya que su variedad de presentación, lleva salvataje

Analysis of status of surgery in thoracic tuberculosis.

A retrospective analysis of the surgical procedure in 1655 patients in twenty years in a university hospital for thoracic tuberculosis revealed that the varieties of procedures were necessary in 2.2% cases only. They can be grouped as tubercular empyema with or without bronchopleural fistula in 1507 (91%), complicated pulmonary tuberculosis in 78 (4.7%), cold abscess in the chest wall with or without lymphadenitis in 54 (3.2%) and osteomyelitis of the ribs and sternum in 16 cases (0.9%). This is statistically significant with a confidence interval of 0.1248 to 0.2348. In tubercular empyema 222 procedures were performed of which 162 were minor procedures, intercostal drainage with irrigation: 89 cases, thoracostoma: 56 cases and continuous chest wall tube 17 cases and 60 were major procedures (decortication in 45 cases, thoracoplasty [modified] in 14 cases and muscle transfer in one case). All the above procedures were preceded by an intercostal drainage. In complicated pulmonary tuberculosis the operative procedures were as follows: lobectomy in 33 cases, pneumonectomy in 35 cases and thoracoplasty in 10 cases. Drainage of cold abscess with or without lymphnode resection was performed in 54 cases and in 16 cases of osteomyelitis of the ribs and sternum resection were necessary. All procedures were performed under the cover of antitubercular therapy and supportive treatment with the aim of resolution of process, obliteration of the empyema space, control of sepsis and improvement of activity performance. The morbidity was extensive and mortality was high in major procedures. Good results could be obtained in over 92% cases, and only 66.2% on major surgery cases.

Problemas diagnósticos na tuberculose óssea: experiência da Area de Ortopedia do HCFMRP-USP / Diagnostic problems in bone tuberculosis: experience in the Orthopedics Area of HCFMRP-USP

Foi realizado estudo retrospectivo de 74 pacientes portadores de tuberculose óssea, atendidos pela Area Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto da USP, com o objetivo de analisar os dados epidemiológicos, clínicos e laboratoriais e radiológicos dos pacientes. Observou-se predomínio da tuberculose óssea nos pacientes brancos (33, 4 por cento) do sexo masculino (39 por cento) e na faixa etária dos 21 aos 30 anos. A localizaçao mais freqüente dessa patologia foi a coluna vertebral (82,4 por cento) e observou-se uma grande dificuldade para a confirmaçao do diagnóstico dessa patologia, que foi muitas vezes realizado tardiamente, devido principalmente a maneira inespecífica como a doença osteoarticular se manifestou e também ao baixo índice de suspeiçao da mesma.

Tuberculous disease in a pediatric referral centre: 16 years experience.

Children with evidence of tuberculous disease registered at the TB Clinic, Institute of Child Health, Madras during the years 1977 to 1992 were analyzed. Progressive primary complex, is the commonest thoracic form of tuberculosis while tuberculous meningitis is the commonest extra thoracic form. The overall prevalence of various clinical forms of tuberculosis has decreased over the last 16 years. There is an increasing trend in the prevalence of progressive primary complex among the BCG vaccinated group. The prevalence of pleural effusion, bone tuberculosis and abdominal tuberculosis is almost same over the last 16 years and is more in the BCG non vaccinated children. In tuberculous adenitis there is no significant variation between the two groups. The occurrence of tuberculous meningitis is in the ratio of 1:3 among BCG vaccinated and non-BCG vaccinated children. Though the prevalence of miliary tuberculosis is negligible, it is significantly more in BCG non-vaccinated children. There is a tendency for slight decrease in overall mortality due to tuberculosis in the last 10 years but the mortality due to tuberculous meningitis continues to be the same over the past 16 years.

Epidemiologia da tuberculose óssea: análise de 149 casos no Paraná / Epidemiology of bone tuberculosis: analysis of 149 cases in the state of Paraná, Brazil

Uma análise retrospectiva foi realizada com 12.053 pacientes portadores de tuberculose entre julho de 1988 e dezembro de 1992, tendo sido encontrados 149 cujo foco era osteoarticular. Dentre estes 149 pacientes, foram determinadas algumas características epidemiológicas, tais como: dados demográficos, local de origem, tratamento anterior para tuberculose, cicatriz vacinal por BCG, contato com pacientes portadores de tuberculose, bacterioscopia do escarro para BAAR, resultado do teste tuberculínico, achados no raio X de tórax, ano do diagnóstico inicial e tratamento instituído. Todos os pacientes incluídos neste estudo encontravam-se residindo no Estado do Paraná na época do diagnóstico. Os resultados demonstraram que a maioria dos pacientes era homem, branco, estava na quarta década de vida, morava no leste do Estado do Paraná, sem tratamento prévio para tuberculose, sem cicatriz vacinal, sem contato conhecido com pacientes portadores de tuberculose e recebeu tratamento com o esquema tríplice padronizado (rifampicina + pirazinamida + isoniazida). Näo houve tendência ao aumento ou decréscimo na sua incidência nos anos observados.

Clinicosocial aspect of osteo-articular tuberculosis.

The study constituted clinicosocial analysis of 194 cases of osteo-articular tuberculosis. The disease was common in 1st and 2nd decades of life but not rare in old age with male preponderance. Majority of the patients were from rural area belonging to lower economic classes. Lesions were usually solitary (96.4%) situated in the weight bearing bones and joints (88.66%). Spinal tuberculosis was commonest (48.97%). The onset of disease was insidious in 94.8% cases. Chronic pain, swelling, impaired movements, deformities, sinus and cold abscess were found to be salient features of disease. Negligence and secondary infection were common.

Tuberculose osteoarticular no Hospital Municipal Jesus nos últimos 17 anos / Osteoarticular tuberculosis in Hospital Municipal Jesus at the last 17 years

Foram tratados e acompanhados no Serviço de Ortopedia e Traumatologia do Hospital Municipal Jesus, no período de 1972 a 1988, 139 pacientes portadores de tuberculose osteoarticular, representando 28 por cento dos casos de tuberculose doença, matriculados no hospital no referido período. Os autores apresentam os resultados da análise retrospectiva dos pacientes, expondo a rotina adotada pelo serviço e a evoluçäo dos casos, tirando algumas conclusöes

Tuberculosis osteoarticular en el Hospital Nacional Edgardo Rebagliati Martins / Osteoarticular tuberculosis in Hospital Nacional Edgardo Rebagliati Martins (HNERM)

Se realizó un estudio retrospectivo sobre tuberculosis osteoarticular en el Hospital Nacional "Edgardo Rebagliati Martins" (HNERM), en el período de 1975-1985. De los 66 pacientes estudiados (39 hombres y 27 mujeres) con un rango de 11-76 años de edad, más del 50 por ciento eran menores de 40 años. La tuberculosis osteoarticular fue el 1.58 por ciento del total de casos de tuberculosis atendidos, ocupando el tercer lugar entre las tuberculosis extrapulmonares. Existe retardo en el diagnóstico, en más del 25 por ciento se hizo después de 18 meses de iniciada la enfermedad. Las localizaciones más frecuentes fueron: columna (30 por ciento), rodilla (30 por ciento) y cadera (17 por ciento). El traumatismo fue el factor predisponente más frecuente. De las formas clínicas de tuberculosis osteoarticular, la monoartritis es más frecuente (54.6 por ciento), seguida por espondilitis (34.8 por ciento), oligoartritis (6.4 por ciento), poliartritis (1.6 por ciento); siendo dolor la manifestación común a todas ellas. La radiología típica fue de gran utilidad para el diagnóstico y, la artroscopía, en los casos de monoartritis de rodilla. Desde fines de 1981, el empleo de 4 drogas ha permitido acortar el tiempo de tratamiento (de 18-24 meses a 12-14 meses).

Clinical Observation on Skeletal Tuberculosis

In this study, 47 cases of tuberculous osteitis treated at Severance Hospital from March 1968 to February 1978 were analysed clinically and the following results were obtained.: 1) The sexual incidence was 23 ma1e and 24 female patients. 2) There were 18 cases in the pediatric group and 29 cases in the adult group. 3) The most frequent site was rib (36%), followed by the trochanter of femur (21%) and the proximal portion of humerus (15%). 4) Thirty-seven percent of the cases showed some form of pulmonary tuberculous infiltration. 5) Erythrocyte sedimention rate was increased in 33 cases (70%). 6) The condition was managed medically with triple antituberculosis drugs and surgically with curettage, curettage with bone graft, and partial resection of ribs, etc.